ice引导下脉冲场消融分离上腔静脉的结果。

IF 8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Clinical electrophysiology Pub Date : 2025-04-01 DOI:10.1016/j.jacep.2024.11.009

Nicola Pierucci MD , Vincenzo Mirco La Fazia MD , Sanghamitra Mohanty MD , Marco Schiavone MD , Brandon Doty MD , Kirollos Gabrah DO , Domenico G. Della Rocca MD , J. David Burkhardt MD , Amin Al-Ahmad MD , Luigi Di Biase MD , Michela Casella MD, PhD , Antonio Dello Russo MD, PhD , Devi Nair MD , Moussa Mansour MD , Claudio Tondo MD, PhD , Andrea Natale MD

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引用次数: 0

摘要

背景：早期的研究表明，射频导管消融电隔离上腔静脉（SVCI）的并发症有窦房结损伤和膈神经麻痹的风险。目的：本研究的目的是评估心房颤动患者接受脉冲场消融（PFA）时SVCI的安全性和可行性。方法：616例连续接受PFA肺静脉隔离+ SVCI的患者被纳入这项多中心分析。上腔静脉（SVC）消融在持续超声心动图指导下进行。PFA导管放置于右心房与SVC交界处肺动脉下缘处。为了实现SVC的完全电气隔离，总共给出了4种应用。术中、出院前及随访2个月检查窦结损伤及膈神经休克情况。结果：共纳入616例接受SVCI的患者。616例患者均实现急性SVCI（100%）。在前10例患者中，观察到2例短暂性窦结损伤和2例膈神经昏迷，这些损伤在手术过程中自行消退。在其余患者中，使用篮子配置；仅有1例膈神经昏迷，并在手术结束前恢复。出院时和随访2个月时均未发现永久性损伤。结论：超声心动图引导下的PFA可有效分离SVC，安全性好。

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Results of ICE-Guided Isolation of the Superior Vena Cava With Pulsed Field Ablation

Background

Earlier studies have documented the risk for sinoatrial node injury and phrenic nerve paralysis as complications following radiofrequency catheter ablation for electrical isolation of the superior vena cava (SVCI).

Objectives

The aim of this study was to assess the safety and feasibility of SVCI in patients with atrial fibrillation undergoing pulsed field ablation (PFA)

Methods

A total of 1,600 consecutive patients undergoing PFA for pulmonary vein isolation plus SVCI were included in this multicenter analysis. Superior vena cava (SVC) ablation was performed under the continuous guidance of intracardiac echocardiography. The PFA catheter was placed at the junction between the SVC and the right atrium at the level of the lower border of the pulmonary artery. A total of 4 applications were given to achieve complete electrical isolation of the SVC. Sinus node injury and phrenic nerve stunning were checked during the procedure, before discharge, and at 2-month follow-up.

Results

A total of 616 patients receiving SVCI were included in the analysis. Acute SVCI was achieved in all 616 patients (100%). In the flower configuration used in the first 10 patients, 2 transient sinus node injuries and 2 episodes of phrenic nerve stunning were observed, which resolved spontaneously during the procedure. In the remaining patients, the basket configuration was used; only 1 episode of phrenic nerve stunning was registered, which regressed before the end of the procedure. No permanent damages were registered at discharge and at 2-month follow-up.

Conclusions

Intracardiac echocardiography–guided PFA can effectively isolate the SVC with a good safety profile.

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来源期刊

JACC. Clinical electrophysiology CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

10.30

自引率

5.70%

发文量

250

期刊介绍： JACC: Clinical Electrophysiology is one of a family of specialist journals launched by the renowned Journal of the American College of Cardiology (JACC). It encompasses all aspects of the epidemiology, pathogenesis, diagnosis and treatment of cardiac arrhythmias. Submissions of original research and state-of-the-art reviews from cardiology, cardiovascular surgery, neurology, outcomes research, and related fields are encouraged. Experimental and preclinical work that directly relates to diagnostic or therapeutic interventions are also encouraged. In general, case reports will not be considered for publication.